Provider Demographics
NPI:1841651114
Name:SHORT, MELINDA YVETTE (AGACNP-BC, BSN, RN)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:YVETTE
Last Name:SHORT
Suffix:
Gender:F
Credentials:AGACNP-BC, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4048 CEDAR BLUFF DR STE 1
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8895
Mailing Address - Country:US
Mailing Address - Phone:231-348-4005
Mailing Address - Fax:833-973-5899
Practice Address - Street 1:630 W MITCHELL ST STE 4
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2214
Practice Address - Country:US
Practice Address - Phone:231-348-4005
Practice Address - Fax:833-973-5899
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704319747363LA2100X, 163W00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care